Body image and psychological outcome after severe skin and soft tissue infection requiring intensive care.

BACKGROUND: Patients with severe skin and soft tissue infection (SSTI) requiring intensive care unit (ICU) stay are commonly treated with antibiotics, surgery and in some centers also with hyperbaric oxygen therapy. Long-term follow-up of body image and psychological outcome has not been described despite extensive surgery, potentially altered body image and subsequent psychological problems. The aim was to describe perceived body image and its relation to anxiety, depression and post-traumatic stress disorder (PTSD)-related symptoms in patients with severe SSTI 1 year after ICU stay. Specifically, we aimed to assess potential differences related to gender and anatomic site of infection. METHODS: Fifty patients treated for severe SSTI in the General ICU, Karolinska University Hospital 2008-2010 received the body image scale (BIS), impact of event scale (IES), and hospital anxiety and depression scale (HADS) 1 year after ICU discharge. RESULTS: Abdominoperineal SSTI was associated with more body image problems than other anatomic sites of infection in both men and women. Generally, women reported higher BIS scores than men (median 9.5 vs. 3.0 of total 30, P < 0.03) indicating more negative body image. A substantial number of patients reported scar dissatisfaction (63.9%), body dissatisfaction (51.1%) and body feeling less whole (51.0%). BIS scores correlated with HADS anxiety (r = 0.59, P < 0.01), depression (r = 0.60, P < 0.01) and IES (r = 0.61, P < 0.01) scores. CONCLUSION: One year after severe SSTI requiring intensive care, women and patients with abdominoperineal SSTI reported significantly more body image problems. Negative body image was associated with anxiety, depression and PTSD-related symptoms. Specific follow-up for SSTI patients is warranted.

Quantifying male-biased dispersal among social groups in the collared peccary (Pecari tajacu) using analyses based on mtDNA variation.

Recent advances in the statistical analysis of microsatellite data permit calculation of sex-specific dispersal rates through sex- and age-specific comparisons of genetic variation. This approach, developed for the analysis of data derived from co-dominant autosomal markers, should be applicable to a sex-specific marker such as mitochondrial DNA. To test this premise, we amplified a 449 bp control region DNA sequence from the mitochondrial genome of the collared peccary (Pecari tajacu), and estimated intra-class correlations among herds sampled from three Texas populations. Analyses on data partitioned by breeding group showed a clear signal of male-biased dispersal; sex-specific fixation indices associated with genetic variation among social groups within populations yielded values for females (F(GP)=0.91), which were significantly larger than values for males (F(GP)=0.24; P=0.0015). The same general pattern emerged when the analyses were conducted on age classes (albeit nonsignificantly), as well as categories of individuals that were predicted a posteriori to be dispersers (adult males) and philopatric (adult females and all immatures). By extending a previously published methodology based on biparentally inherited markers to matrilineally inherited haploid data, we calculated sex-specific rates of contemporary dispersal among social groups within populations (m(male symbol)=0.37). These results support the idea that mitochondrial DNA haplotype frequency data can be used to estimate sex-specific instantaneous dispersal rates in a social species.

Minimally invasive treatment of infection staghorn stones with shock wave lithotripsy and chemolysis.

We report the results in 118 patients with infection staghorn stones treated with an anaesthesia-free minimally invasive method that combined repeated shock-wave lithotripsy (SWL) sessions (unmodified Dornier HM3 lithotripter) and percutaneous chemolysis with Renacidin. The stone-free rate was 60%. In 27 consecutive patients with infection staghorn stones representative of patients with this stone type in the population, a stone-free rate of 77% was recorded. The latter figure is comparable with results reported for open surgery, percutaneous surgery and sandwich therapy, and superior to that recorded with SWL alone. During the study period, no patient referred to us with an infection staghorn stone was treated with percutaneous, ureteroscopic or open surgery, and all treatments were carried out without regional or general anaesthesia. The described treatment concept had a very low complication rate, but required a fairly long hospital stay, with a mean of 32 days (range: 5-82). The long period necessary for completing the treatment in the most complicated cases might render the procedure less attractive as a standard method, but it is nevertheless an excellent option in high-risk patients and in all those patients in whom other procedures are impossible.

Cholinesterase activity in white-winged doves exposed to methyl parathion.

Captive white-winged doves (Zenaida asiatica) were exposed to various levels of methyl parathion (MP) in drinking water to determine effects on brain and blood cholinesterase (ChE) activity. We conducted two experiments to test the influence of MP dose (the amount of MP actually ingested), MP concentration (the amount of MP per unit water), and exposure duration (number of days exposed to a constant MP concentration) on ChE activity. Plasma ChE activity was not useful in predicting brain ChE activity. Methyl parathion concentration had a greater influence on plasma and brain ChE activity levels than dose or time of exposure. These results contribute to the evaluation of irrigation water as a route of exposure of wildlife to pesticides.

Thyroid hormone concentrations in black bears (Ursus americanus): hibernation and pregnancy effects.

Previous studies on thyroid hormones in hibernating bears have used very few sampling periods, so that the time course of any change is poorly understood. In this study, plasma sampled from pregnant and nonpregnant black bears before and during hibernation (16 samples each at 10-day intervals) was assayed by radioimmunoassay for concentrations of thyroxine (T4) and triiodothyronine (T3). Only free T4 showed a difference (P = 0.019) between females that produced cubs and those that did not, but this appeared to be due to higher preimplantation values. Free T3, total T3, and free T4 varied (P = 0.001, 0.038, 0.002, respectively) among sampling periods: during December, bears had depressed concentrations. These lowered concentrations were maintained during hibernation for the free hormones. Our data confirm previous work showing that food restriction and/or physiological preparation for hibernation is coincident with depressed plasma concentrations of thyroid hormones. Hormonal changes associated with pregnancy were minor.

Sodium economy in white-tailed deer (Odocoileus virginianus).

Sodium is considered the mineral most limiting to growth and reproduction of mammalian herbivores worldwide. Notwithstanding the large database on physiological adaptations to low sodium intake, information on maintenance sodium requirements and sodium dynamics of mammals is depauperate. We measured sodium intake and output in adult, nonreproductive white-tailed deer (n = 15) over four seasons to estimate daily requirements for sodium on a seasonal and an annual basis. Dietary sodium content was based on best available predictions of sodium requirements. With regression techniques, we estimated metabolic fecal excretion and endogenous urinary losses of sodium. Average daily sodium requirement, defined as the minimum sodium intake at which intake equaled excretion, was estimated to be 3.27 mg kg-1 body mass d-1. Seasonal estimates did not vary. We propose that sodium requirements for maintenance in mammalian herbivores scale to body mass at an exponent that is similar to that for metabolic rate and forage intake (0.71-0.75). Development of an allometric relationship between sodium need and body mass would permit stronger inference regarding the role of sodium in population regulation, foraging decisions, or distribution and movements of mammalian herbivores.

Immobilization of collared peccaries (Tayassu tajacu) and feral hogs (Sus scrofa) with Telazol and xylazine.

A 1:1 mg mixture of Telazol and xylazine hydrochloride (100 mg of Telazol and 100 mg of xylazine per ml) was used to immobilize wild collared peccaries (Tayassu tajacu) and feral hogs (Sus scrofa); mean (+/-SD) intramuscular dosage rate was 4.73 +/- 0.86 mg/kg and 4.35 +/- 0.68 mg/kg for peccaries (n = 107) and hogs (n = 49), respectively. Mean (+/-SD) induction time (time from injection until complete immobilization) was 4.6 +/- 2.5 minutes for collared peccaries and 4.4 +/- 1.9 for hogs. Peccaries became conscious at 64 +/- 29 minutes and first stood at 92 +/- 33 minutes after initial injection. Hogs became conscious at 54 +/- 26 minutes and first stood at 78 +/- 38 minutes after initial injection. A 1:1 mg mixture of Telazol and xylazine provided an effective and safe method to immobilize both species and provided adequate analgesia and anesthesia for short surgical procedures.

Coccidia of the collared peccary (Tayassu tajacu) in southern Texas with descriptions of three new species of Eimeria (Apicomplexa: Eimeriidae).

In February 1993, fresh fecal samples were collected from 47 collared peccaries (Tayassu tajacu) killed by hunters at the Chaparral Wildlife Management Area, southern Texas, USA. Five species of coccidia (Eimeria chaparralensis n. sp. [9/47, 19%], Eimeria dicotylensis n. sp. [21/47, 21%], Eimeria pecari n. sp. [2/47, 4%], Eimeria sp. [1/47, 2%], and Klossia sp. [1/47, 2%]) were observed. Measurements are in micron. Sporulated oocysts of E. chaparralensis are rough-walled, elongate ovoidal, 43.3 x 28.5 (37-52 x 26-35); sporocysts are elongate ellipsoidal 21.8 x 9.0 (16-27 x 7-12); micropyle (approximately 4.9), Stieda, and substieda body are present; sporocyst residuum is present in newly sporulated oocysts; polar granule and oocyst residuum are absent. Sporulated oocysts of E. dicotylensis are smooth-walled, ovoidal, 25.7 x 20.1 (23-29 x 17-23); sporocysts are ellipsoidal 13.0 x 6.9 (11-17 x 6-9); micropyle and oocyst residuum are absent; polar body sometimes present; Stieda body and sporocyst residuum always present. Sporulated oocysts of E. pecari are smooth-walled, elongate ellipsoidal, 26.8 x 18.1 (22-31 x 15-21); sporocysts are elongate ellipsoidal 16.4 x 5.9 (13-22 x 4-7); micropyle (approximately 5.8) with collar, Stieda body, substieda body, and sporocyst residuum are present; polar granule and small oocyst residuum sometimes present. There were no sex or age differences in prevalences of infection, and there were no positive or negative associations between any species of eimerian. The majority of hosts were infected with a single species of Eimeria. Overall prevalence of infection with eimerians was 23/47 (49%).

Circannual variations in bear plasma albumin and its opioid-like effects on guinea pig ileum.

Previous studies suggest that hibernation is controlled by an opioid system. In this study we examined the effect of plasma albumin fractions drawn from black bears at timed intervals while in hibernation or during the awake state in fall and winter, on induced contractility of the guinea pig ileum. Four hundred nM morphine produced typical suppression of contractility and 400 or 1000 nM naloxone (an opiate antagonist) restored it. Twenty mg of lyophilized albumin fraction from the winter hibernating bear caused similar suppression, the effect being greater than that of either summer bear or winter-active bear plasma albumin. Naloxone reversed the suppression in all cases. Strong suppression of contractility was also demonstrated with 2.5 nM [D-Pen2.5]-enkephalin (DPDPE), a delta agonist, but only minor suppression with 2.5 nM dynorphin A, a kappa agonist. Results support the opioid nature of the albumin-bound hibernation-induction trigger substance, that it binds to the delta opiate receptor, and that delta agonist opioid production may increase during the hibernation season.

Clinical course and cystine stone formation during tiopronin treatment.

The formation of stones in patients with cystinuria can be counteracted by reducing the urinary concentration of cystine and by increasing its solubility. Thirty-one patients with homozygous cystinuria and treated with tiopronin (2-mercaptopropionylglycine) were followed for between 0.4 and 12 years (median 8.8). With the aim of avoiding cystine concentrations above 1200 mumol/l, the daily dose varied between 500 and 3000 mg (median 1500). The therapeutic effect was evaluated from the clinical symptoms and repeated radiographic examinations. The rate of stone formation during the treatment period was reduced by 60% in comparison with the pretreatment period (P < 0.001). The frequency of active stone removal was reduced by 72% (P < 0.05). The formation of new stones was associated with a higher cystine concentration than was the case during periods when stone formation and stone growth were excluded (P < 0.05). The probability of new stone formation increased with increasing concentrations of cystine up to 1100 mumol/l, but stone formation was not accentuated above 1200 mumol/l. There was no significant relationship between the 24 h excretion of cystine and stone formation. It is concluded that the formation of cystine stones can be efficiently counteracted during treatment with tiopronin, guided by analysis of the concentration of urinary cystine.

Glycosylated hemoglobin as a stable alternative to serum glucose in white-tailed deer.

We compared serum glucose concentration and percent glycosylated hemoglobin (GH) in captive and wild white-tailed deer (Odocoileus virginianus) to determine stability of glucose relative to GH. Temporal changes in levels of serum glucose and GH were ascertained from serial blood samples collected from three captive deer over a 2-week period. State of glycemia also was determined for 17 wild deer that were collected from three populations in southeastern Oklahoma and southwestern Arkansas (USA). Concentration of serum glucose of captive deer decreased (P = 0.04) from 190.4 to 155.8 mg/dl over the 2 weeks; percent GH did not differ temporally (P = 0.30). Percent GH of wild deer did not differ (P = 0.23) when deer were separated into 2 groups (high and low state of glycemia) based on the median serum glucose concentration. We found a significant difference (P = 0.04) in percent GH among wild deer populations; serum glucose concentration did not differ (P = 0.72) among populations. Our results indicate that percent GH is more stable than serum glucose concentration and may be useful in population comparisons of nutritional condition.

Minimally invasive treatment of hemiacidrin soluble staghorn renal stones.

Among 78 patients with hemiacidrin soluble staghorn renal stones, 23 were treated with a combination of one session of percutaneous debulking and high-energy extracorporeal shock wave lithotripsy (ESWL) (Group A); 17 were treated with high-energy ESWL only (Group B); and 38 were treated with low-energy only ESWL (Group C). In all patients percutaneous nephrostomies were inserted and the ESWL procedure was followed by hemiacidrin irrigation. ESWL was performed with anesthesia in Groups A and B, but without anesthesia in Group C. Groups A and B did not differ in number of ESWL sessions or length of hospital stay, and the therapeutic results at discharge and at 6-month follow-up were comparable, whereby 59% of the patients in both groups were either stone-free or had only small ( less than or equal to 3 mm) residual fragments. In Group C more ESWL sessions were performed, and the hospital stay as well as the hemiacidrin irrigation periods were longer. The fraction of stone-free renal units at discharge was significantly higher in Group C than in Group A (p less than 0.05) and after 4 weeks higher than in both Groups A (p less than 0.025) and B (p < 0.05). At 6 month follow-up, 92% of the patients in Group C were either stone-free or had only small ( less than or equal to 3 mm) residual fragments. Combined low-energy ESWL and hemiacidrin irrigation can successfully be used for treatment of even very large infection staghorn stones.

Rectal temperatures of immobilized, snare-trapped black bears in Great Dismal Swamp.

Rectal temperature was determined for 84 black bears (Ursus americanus) during 99 handlings in Great Dismal Swamp, Virginia and North Carolina (USA). All bears had been trapped with cable snares and immobilized with a 2:1 ketamine hydrochloridexylazine hydrochloride mixture. Temperatures were significantly greater in males and varied significantly by season. Immobilized bears began panting at rectal temperatures greater than 42.0 C. One death occurred at 43.0 C. We recommended cooling measures on black bears at rectal temperatures of greater than or equal to 40.0 C.

Seasonal variation in serum testosterone, testicular measurements and semen characteristics in the collared peccary (Tayassu tajacu).

Blood samples and testicular measurements were obtained from 4-8 captive adult collared peccaries monthly for 18 months and from wild adult males during summer (N = 16) and winter (N = 22) seasons. Serum concentrations of testosterone were determined by radioimmunoassay. Semen samples were collected monthly by electroejaculation from captive males for 1 year. Serum testosterone concentrations and testicular measurements varied in a low-amplitude circannual pattern, with maximum mean testosterone concentrations in fall and winter (1150-1400 pg/ml) and minimum values in summer (500-700 pg/ml). Circannual rhythms appeared to be related to dominance. Serum testosterone levels in wild males generally were lower than in captive males, although this difference was not significant (P greater than 0.05). Semen characteristics did not exhibit a circannual rhythm. These results suggest that the male peccary remains reproductively fertile throughout the year, yet may undergo a facultative summer quiescence influenced by ambient temperature and social factors.

Indices for physiological assessment of nutritional condition in pregnant collared peccaries (Tayassu tajacu).

Hematological and serum biochemical responses to two levels of dietary energy (high energy [HE], 3300 kcal digestible energy [DE]/kg; moderate energy [ME], 2300 kcal DE/kg) and protein (high protein [HP], 16.0% crude protein; moderate protein [MP], 8.4% crude protein) during gestation in 15 collared peccaries (Tayassu tajacu) were examined. Dietary energy and protein levels influenced body weight gain during gestation. Red blood cell counts and lymphocyte concentrations were higher and neutrophil concentrations were lower among females fed an HP diet compared to those fed an MP diet. Alkaline phosphatase and alpha-2 globulin concentrations were higher among females fed an MP diet. Aspartate aminotransferase and cholesterol concentrations were higher and calcium and thyroxine concentrations were lower among females fed ME diets compared to those fed HE diets. These results suggest that physiological indices used in combination with morphological measurements can be useful in assessing collared peccary nutritional health during gestation.

Classification of patients subjected to extracorporeal shock wave lithotripsy.

A simple system is described for classification of patients with urolithiasis treated with extracorporeal shock wave lithotripsy (ESWL). According to the size and number of concrements in each kidney the patients were subgrouped in six different ESWL-types (A-F). The main purpose was thereby to be able to discriminate between different stone situations regarding the need for resources and to evaluate the therapeutic results in an appropriate way. Of 709 patients treated with ESWL during the first year, 2% were of ESWL-type A, 46% of type B, 24% of type C, 16% of type D, 5% of type E, and 7% of type F. There was a good relationship between ESWL-type, number of shock waves and duration of the treatment session, number of ESWL-sessions, and duration of hospital stay. With knowledge of the ESWL-type distribution in a group of patients with urolithiasis this classification provides a basis for estimates of treatment capacity and required number of beds. With a weekly capacity of 24 treatments the required number of beds usually varied between 20 and 25. The hospital stay varied between 2 and 35 days, with the longest hospital stay recorded for patients belonging to ESWL-type E undergoing a combined procedure with percutaneous surgery, ESWL, and often irrigation with hemiacidrin. The presented system for classification might be a useful tool for planning, organization and assessment of renal stone treatment based on ESWL.

Urea concentration in collared peccary milk as an indicator of protein nutritional status.

Milk urea nitrogen (UN) concentration was examined as a possible index to protein-energy intake in female collared peccaries (Tayassu tajacu). Captive adults were bred and assigned to one of four experimental diets through gestation and lactation. Females fed a high protein diet produced milk with UN concentrations exceeding those of low-protein-fed females. A low energy intake tended to elevate UN concentrations in milk.

Vitamin A levels of blood in collared peccaries (Tayassu tajacu) from south Texas.

Serum vitamin A concentrations were determined for 24 adult female collared peccaries from 1 captive and 2 wild populations during the period 30 January-15 March, 1983. Normal serum vitamin A concentrations of well-fed captive peccaries (mean = 39.0 micrograms/dl) were slightly higher than the reported range of values for domestic swine. Mean vitamin A concentrations of blood serum did not differ among the captive and 2 wild populations. However, a few individuals from the wild populations had low serum levels of vitamin A which suggested a possible vitamin A deficiency for these females.

Biochemical risk factors in patients with renal staghorn stone disease.

Thirty-three patients operated on for renal staghorn calculous disease were studied retrospectively with respect to urine and stone composition, bacteriuria, and abnormalities of the urinary tract. Calcium phosphate was the most common stone constituent, present in 30 of 31 concrements. Twenty-one of these stones also contained magnesium ammonium phosphate, despite the fact that only 10 patients had presented evidence of urinary tract infection during the initial period of the disease. Twenty-four-hour urine composition was normal in only 3 patients. In 59 per cent an increased CaOx risk index was observed suggesting that CaOx risk factors might contribute to the development of staghorn concrements. A metabolic evaluation of staghorn stone formers appears to be of importance for design of the postoperative treatment.

Clinical results of allopurinol treatment in prevention of calcium oxalate stone formation.

Allopurinol in a daily dose of 300 mg. was administered to 99 patients with calcium oxalate stone disease. Treatment was started irrespective of urine composition and was continued for up to 8 years. Only 43 per cent of the patients treated for 5 or more years remained free of further stone formation, a result not better than observations in untreated stone patients. When patients were subgrouped with respect to recurrent or nonrecurrent stone formation during treatment, the former group, besides being followed for longer intervals than the latter group, had a urine composition suggesting a higher crystallization risk. We concluded that with the possible exception of hyperuricosuria or hyperuricemia the indication for allopurinol treatment of recurrent calcium oxalate stone disease is weak. The results also demonstrate clearly the problems combined with evaluation of prophylactic medical therapy in patients with calcium stones. The necessity of long-term followup and analysis of the biochemical risk situation is emphasized.